Inspection on 09/05/06 for The Douglas Arter Centre

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Douglas Arter Centre 05/01/06

The Douglas Arter Centre 04/08/05

The Douglas Arter Centre 18/01/05

The Douglas Arter Centre 01/06/04

The Douglas Arter Centre 02/03/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Douglas Arter Centre (The) Odstock Road Salisbury Wiltshire SP5 4JL Lead Inspector Alison Duffy Key Unannounced Inspection 9th May 2006 09:30 Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Douglas Arter Centre (The) Address Odstock Road Salisbury Wiltshire SP5 4JL 01722 320318 01722 421537 douglas.arter@scope.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) SCOPE Mrs Susan Janet Brown Care Home 9 Category(ies) of Physical disability (9) registration, with number of places Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: The Douglas Arter Centre is a residential care home registered to care for nine adults with a physical disability. The home is situated on the outskirts of Salisbury near the citys hospital. The home is managed by SCOPE and the Registered Manager is Mrs Susan Brown. The Douglas Arter Centre is purpose built and also consists of an integral day centre. All areas on the ground floor provide full disabled access. Offices, staff rooms and the sleeping in room are located on the first floor. The home has nine single rooms, which are all personalised and individual in style. There is a small lounge although service users are also able to use the main lounge in the day centre as required. There are specialised bathing facilities and a range of specialist equipment including overhead hoists in bedrooms. During the week, staffing levels are maintained at a minimum of five staff in the morning and four in the evening. At weekends this reduces to a minimum of four within the morning shift. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on 9th May 2006 between 9.30am and 5.30pm. Ms Kerry Grinter, Team Leader of the Residential Service, initially assisted the inspector and Mrs Sue Brown later continued, when she arrived for duty. Discussion took place with Ms Sue Linington, Team Leader of the Day Service in relation to training and day service activities. The administrator, assisted with recruitment documentation. Other members of staff were met with during the visit and a number of service users were spoken with. Various interactions were observed including staff assisting service users with preparing lunch. During such observation it was noted that staff were fully engaged with service users and communicated effectively in a respectful manner. A tour of the accommodation was made and varying documentation was viewed. This included care planning information, health and safety material and staffing documentation. Due to complex disabilities, service users were unable to give substantial feedback about the service received. Comment cards were forwarded to each service user’s primary relative and a number of health and social care professionals. A good response was received and many comments are included within the main text of this report. A number of conversations also took place on the telephone. Of those responses, all were satisfied with the overall care provided. One relative reported that she could not sing the praises of the home enough. A care manager also confirmed that ‘the care provided is of a high standard and there are no concerns regarding the service at all.’ All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. Such matters are described in detail within this report The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views raised on behalf of service users. What the service does well: The Douglas Arter Centre is very service user focused and each service user’s wellbeing is paramount. Staff are motivated and have a clear awareness of individual need which is viewed from an holistic view point. Despite some service users very complex needs, various systems are in place to enable decision-making, independence and general involvement. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 6 Care planning is of a very good standard. All documentation is well written, detailed and up to date. Service users’ personal care needs are well met with consistent, regular input from specialised services. The environment is well maintained and decorated and furnished to a high standard. Private accommodation is personalised showing individuality. Established well-managed systems such as the complaints procedure are in place, which demonstrate a commitment to service users and service provision. The home gives priority to health and safety matters and operates a thorough risk assessment process. The home is well managed with organised management and administrative systems in place. What has improved since the last inspection? What they could do better: While care planning is of a very good standard, conditions such as epilepsy would benefit from a specific section. External activity although occurring, is not fully evidenced and therefore Mrs Brown was advised to give consideration to this area. While prescribed medication in tablet and liquid form is appropriately documented, staff must ensure that creams and bath lotions are also fully recorded. Although informal systems are in place to gain views about the service, the home does not have a formal quality assurance system. . Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. The admission process is detailed, organised and well managed thus minimising the possibility of unmet need. EVIDENCE: There have not been any new service users since the last inspection. It was not possible therefore to assess the admission procedure in practice. The home has however detailed admission procedures, devised by SCOPE, which are followed as required. All service users are routinely assessed in detail in order to ensure that individual needs are met. This includes a series of visits to existing placements and to the Douglas Arter Centre. Various discussions are held with all interested parties including relatives, health care workers and staff within previous placements. A detailed plan of care is then established. One service user is currently in hospital and it was evident that Mrs Brown had undertaken a detailed assessment regarding specific care requirements following discharge. These were comprehensively addressed within a shortterm plan and included input from health care personnel as required. Through discussion with staff it was evident that service users, due to their high level of need, are assessed informally on a daily basis. This may include correct posture or specific positioning of straps within a wheelchair. Such aspects are documented accordingly and discussed within handover meetings. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 10 All service users have a contract that demonstrates the terms and conditions of living at the home. Mrs Brown reported that all are in the process of being updated due to the implementation of a new fee structure. Relatives are given a copy of the contract on behalf of the services user and a copy is also kept securely within a locked filing cabinet. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. Care planning is of a good standard thus enabling staff to have the information required to meet service users’ needs. A well-managed risk assessment process minimises the potential risks to service users’ safety and general wellbeing. EVIDENCE: Each service user has a comprehensive, detailed, well-written plan of care. All were up to date and demonstrated clear guidelines of care required. Some had guidelines including photographs identifying the use of specialised equipment. Individual programmes such as physiotherapy were also evidenced within pictorial formats. All service users had clearly written communication and eating and drinking programmes. These programmes had been developed through specialised assessments and were noted to be detailed, comprehensive and easy to follow. Some information is documented in the form of charts. This applies to epilepsy and the chart highlights the number and type of seizures suffered. Within the plan however, epilepsy received little attention and therefore Mrs Brown was advised to address this accordingly. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 12 Monthly key worker summary formats were in place. These were reported to be a form of review as well as a tool to summarise information for easy reference. All care plans demonstrated involvement from service users and/or their representative. Within care planning information, the importance of decision-making is addressed. Documentation highlights individual wishes and gives programmes, which identify the most appropriate forms of communication. This may include concise speech, gestures and expressions as well as formal systems such as signing and pictorial forms. The key-worker system is an invaluable tool, which promotes the relationship and uses the staff member’s experience to identify responses. When observing within the cookery group it was evident that a high level of interaction was taking place. Various systems were in operation in order to enable service users to make decisions regarding their involvement. Some service users, however, require staff to make all decisions on their behalf. In this instance, parents or representatives are consulted with. Details are then clearly recorded within care planning information. Relatives confirmed this within comment cards and also stated that they are kept informed of all matters. Due to service users high level of need, the risk assessment process is very carefully considered. A high number of documented risk assessments are in place, which cover matters associated with care provision, daily living and social activities. The assessments are clear, specific, well written and demonstrate the individuality of service users. Many are undertaken in consultation with specialised services. Within discussion it was evident that quality of life is important and therefore service users are exposed to potential risks such as having a seizure when swimming. Levels of dependency also contribute to the level of risk taking. For example one service user, following an assessment period, regularly travels independently with a known taxi company. Another service user however, with greater need would not be exposed to this. Through discussion it was evident that staff are fully aware of individual needs and such matters are regularly addressed within the staff team. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. The Douglas Arter Centre is service user focused enabling individual rights to be promoted. Service users are assisted to undertake meaningful activity and maintain important relationships. Although meal provision appears satisfactory, service users do not fully encounter the benefits of good ‘home cooking.’ EVIDENCE: Service users continue to attend the integral day service and Salisbury College. A varied programme has been devised for each service user dependent on individual need and ability. This may include topics such as letter writing, art, drama and music therapy. As well as purposeful activity, service users continue to have access to a wide range of specialist input such as physiotherapy, speech and language and occupational therapy. Some service users have developed peer support through attendance at College and a wide range of external activity is also received through this. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 14 Within feedback following the inspection one relative confirmed ‘our daughter has been at DAC for 18 years now. We are very happy with the care and stimulation she receives and can not speak too highly of the Centre or the Staff.’ Another view stated ‘our daughter is extremely happy at DAC. She has friends and people who care for her with respect and kindness. She has a young key worker who enables XX to do all sorts of activities that would be otherwise be difficult. Long may it continue!’ Staff undertake one-to-one work with service users and encourage involvement with the local community through the use of local facilities. The Douglas Arter Centre has its own transport although public transport is also used. All activities are linked to individual need and interest. Recent trips out have included the New Forest, the pub and cinema. At the last inspection feedback concluded that service users would benefit from greater external activity. Mrs Brown reported that trips out particularly at weekends are a regular occurrence and are now documented within a dairy. One-to-one spontaneous trips also take place. Through looking through the diary however, it was evident that not all occasions are documented and therefore an accurate picture is not portrayed. Mrs Brown was advised to consider ways in which external activity can be evidenced. All service users are registered on the electoral role. Staff, were observed to be very friendly, relaxed and approachable. All were motivated and engaged well with service users and other professionals. Through discussion it was evident that staff members have built established relationships with service users and their families. The involvement of parents is viewed as paramount and therefore regular discussions take place. One member of staff confirmed the importance of the parental role and added that transport is often provided to enable contact. Visitors are welcomed at any time and may use service user’s private accommodation in order to receive privacy as required. Hospitality was evident on the day of the inspection and through feedback about the service such hospitality appears general practice. Six relatives within comment cards confirmed that the owners and staff make them feel welcome and they can visit in private. As stated earlier in this report, service users are encouraged to make decisions in relation to their ability. The home is very service user focused and promotes individual rights in a respectful manner. Preferred routines are clearly identified within care planning information and specific programmes give greater clarity so that individual needs can be met. Privacy is maintained through established practices of undertaking personal care in private accommodation or specialised bathrooms. All service users are addressed as they prefer and this is clearly recorded. The main meal of the day continues to be received from Salisbury District Hospital that is adjacent to the home. On a Tuesday however, service users Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 15 cook their own lunch. Staff prepare breakfast and will also undertake the evening meal if the hospital food is not appropriate to service users’ needs. Service users are able to choose their meal from a number of alternatives and specific low sugar, low fat and healthy eating menus are available. Staff reported, that on the whole the food is satisfactory. On occasions however an alternative is made to substitute what is provided. Staff sometimes make the decision of meal provision due to the inability of some service users to make a choice. This is undertaken taking into account known likes, dislikes and consistencies of food. During the inspection, service users, with staff assistance, were observed making their own lunch. This was a highly productive and interactive session with full involvement of service users based on abilities. Practises such as signing and hand over hand were evident and staff were interacting with service users in a positive, meaningful and attentive manner. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. Service users are assured safe care practises through regular discussions with specialised health care professionals. Individual health care is also wellmanaged and clear medication systems, should minimise the risk of error. EVIDENCE: Service users require full assistance from staff in all aspects of daily living. All such procedures are documented in a clear, detailed and efficient manner within care planning information. A range of individualised equipment is in place and procedures for such are clearly stated. Some service users are unable to express how they wish their care to be delivered. In such instances staff rely on gestures, facial expressions, general contentment and individual communication systems. Advice is gained on a regular basis from specialised services and staff also work closely with family members. It was evident that professional health care personnel also assist with assessments such as manual handling and the use of equipment. The home operates a key worker system and facilitates one-to–one work with service users. Discussion with staff demonstrated that all are very aware of service users needs and productive, trusting relationships have been established. Staff were seen to be attentive and give time to establish the service user’s wishes. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 17 Service users are unable to manage their health care needs and therefore rely on staff to recognise any signs of ill health. Within discussion with staff and viewing daily records it was evident that matters are identified at an early stage and appropriately addressed. All matters such as scratches and marks are documented and monitored accordingly. Service users have access to all health care services and also receive specialised support on a programmed basis within the day service. This includes services such as speech and language therapy, occupational therapy, music and physiotherapy. Appointments with other specialist services, including the dietician are made as required and staff provide transport and support for outpatient hospital appointments as appropriate. Contracts are in place for matters such as wheelchair servicing. Feedback from comment cards sent to GPs confirmed that the home works in partnership and there is always a senior member to confer with. They also felt staff demonstrate an understanding of care needs of service users and specialist advice is incorporated into each care plan. All medication is stored appropriately in a locked wall cupboard in the dining room. A monitored dosage system is used and only shift leaders administer such. Due to levels of disability, service users do not administer their own medication. Medication procedures are clear and the receipt and disposal of medication was evident. All staff had appropriately signed the administration sheets for medication although some creams and bath medications were not recorded. Mrs Brown was therefore advised to ensure staff document all such use. Photographs are in place to minimise error and handwritten instructions were countersigned. Any medication not given was fully documented. Some service users find swallowing medication easier if taken with a soft food such as custard. This is addressed within care planning documentation. Since the last inspection there has been a drug error. The system is clear and therefore the reason appears to be general distraction. Mrs Brown reported however that any member of staff making a drug error would be required to undertake additional training. Within comment cards received from GPs, it was confirmed that medication within the home was appropriately managed. All were also satisfied with the overall care provided. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and after the visit to this service. The home has an open culture, which encourages concerns to be raised and successfully resolved so that service provision can be developed. The risk of abuse to service users is minimised through the home’s efficient systems of adult protection. EVIDENCE: The home has a detailed complaints procedure devise by SCOPE and the process is managed effectively. Complaints however minor are fully investigated and used to develop practice. All are fully recorded within specific formats and responses to complainants are fully evidenced. Mrs Brown and the staff team are committed to listening to views and solving issues. It was explained that honesty and trust are important factors and therefore family members are encouraged to be open instead of worrying about small anxieties that could escalate if not addressed. Mrs Brown aims to be approachable and meet with relatives on a regular basis. Any apparent issues are also discussed within formal review settings. The CSCI has not received any formal complaints regarding the service. Feedback from comment cards confirmed that all relatives are aware of the home’s complaints procedure. One relative also reported ‘the staff and Sue Brown are always ready to listen and take others’ views on board.’ The home has detailed adult protection policies, which are satisfactorily instigated as required. Specific staff have the designated responsibility of adult protection and contact details of the local Vulnerable Adult Unit are Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 19 prominently displayed on the notice board in the main office. A new adult protection training package has recently been introduced and this is being worked through on a rotational basis with staff. Staff with the responsibility of adult protection attend regular refresher courses. Within daily records it was evident that staff are attentive when observing any bruising or marks on service users. Such issues are now addressed within accident reporting procedures so that all can be investigated appropriately. Body charts are also in place. The home has policies and procedures regarding the management of service users’ financial affairs. The home holds a small amount of money for safe keeping for some service users. All such money is stored securely within the safe. A number of these records were viewed and all reflected the amount of cash in place. Numbered receipts were available and each transaction generally demonstrated the signatures of two members. Regular checks of the balance were evident in order to ensure accurate practice. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 29 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. The environment is well maintained, cleaned to a good standard and conducive to service users’ needs. Service users also benefit from private accommodation, which is decorated to a good standard and equipped to meet individual need. EVIDENCE: The Douglas Arter Centre is a large purpose built building, which includes a day service and a residential area. The residential area has nine single rooms, bathroom facilities and a small sitting room. The ground floor provides full disabled access and there is a range of specialised equipment in place throughout the home in order to meet individual need. All equipment is regularly serviced and monitored in relation to the suitability of its usage. Ms Linington reported that a number of new specialist commodes have been purchased and decoration has taken place. This has included four bedrooms and the main bathroom, which is a great improvement. Service users’ private accommodation is decorated and furnished to a high standard. All rooms are individual in style and demonstrate service users’ Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 21 preferences. Despite varying levels of equipment, all rooms continue to remain comfortable, homely and personal. Overhead hoists are now in place for all service users who require them. There have been no changes to the laundry provision and current facilities were reported to meet existing needs. The environment was cleaned to a good standard and documentation demonstrated varying responsibilities of such. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. Staffing levels are maintained in line with the previous Registration Authority. A range of training is offered to staff and service users are protected through an efficient, well-managed recruitment procedure. EVIDENCE: The staffing roster demonstrated that staffing levels are maintained at a minimum of five support workers on duty during the morning and this reduces to four in the afternoon and evening. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. The Douglas Arter Centre has a large staff team and there is also a large bank team to cover shifts as required. Staffing shortages, which occurred in the past, appear to have been resolved and agency usage is now minimal. Six relatives within comment cards reported that they believe there are sufficient staff on duty. The NVQ programme is progressing well and the centre has a number of NVQ Assessors. Development days are regularly provided ensuring individuals are up to date with current information. Within the staff team there are currently ten members of staff with NVQ level 2 and five with level 3. Two members of staff are working towards level 2 and one is undertaking level 3. The Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 23 organisation has a formalised training plan and Ms Linington, a team leader, has the responsibility of coordinating such. Varying topics, including mandatory and care service matters are covered. Mrs Linington reported that all staff are either up to date with their mandatory training or have been allocated dates to undertake such. Food hygiene refreshers have been booked for June and September 2006 and moving and handling was undertaken at the end of last year. Specific training such as stesolid administration has been undertaken by some staff who now undertaken the process. Since the last inspection there have been a number of new staff. Ms Linington confirmed that induction work is currently being undertaken. The required ‘work books’ are being worked through and an additional programme in relation to service users’ needs is also being undertaken. All staff have an individual training profile and training needs are discussed within formal supervision and appraisals. All staff have a job description and regular staff meetings are held. Minutes of such are maintained. Documentation demonstrating the recruitment procedure of two members of staff were viewed. Both highlighted a clear and efficient system whereby the necessary information and checks were in place before the member of staff commenced employment. Documentation also included evidence of the reasons for the appointment such as interview questions and answers. All information was ordered with a checklist available to provide an immediate overview of the process. Following the inspection, one relative reported ‘the staff are absolutely wonderful – they could not be more loving. The care is wonderful and XX is wonderfully looked after. XX has no speech but the staff know her extremely well. The staff know exactly what her needs are and understand her fully.’ The relative continued by saying that the staff work very hard, the care is wonderful and they all deserve top marks.’ Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and after the visit to the service. The Douglas Arter Centre is effectively managed with a service user focus. While feedback is sought from various stakeholders, a formalised system of auditing the service would ensure further development of service provision. Established health and safety systems however, significantly reduce potential risks to service users. EVIDENCE: Mrs Brown has worked at the Douglas Arter Centre for a number of years and has recently completed the Registered Manager’s Award. Mrs Brown is experienced in working with adults with a disability and is always in the process of developing the service currently provided. Mrs Brown is very service user focused which is clearly promoted through the staff team. Mrs Brown is motivated, has a clear focus and works in an organised and effective manner. Positive relationships were seen with both service users and staff. Some staff also spoke highly of her practice. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 25 Service users views are encouraged to give their views. This may be through speech, staff recognising gestures and expressions or systems such as PECS books. Some service users are unable to express their views and therefore links with parents are paramount. Mrs Brown reported that parents are encouraged to be involved as much as possible and informal discussion is a regular occurrence. Formal systems such as parents meetings are also facilitated in order to gain feedback about service provision. The organisation does not as yet have a quality assurance system although Mrs Brown reported that SCOPE is currently addressing this. Various systems are in place to address health and safety. Health and safety forms a mandatory part of the home’s training programme and regular audits take place. A member of staff takes specific responsibility for the subject and regular refresher/updates are provided. Mrs Brown and a senior support worker are also manual handler trainers and therefore spontaneous training can be undertaken. Detailed risk assessments are in place including generic matters and those that are service user specific. All are up to date and give a high level of detail. Following a recommendation at the last inspection to review the reporting procedures of bruising, all such matters are now documented within the accident book. All entries are well written, clear and factual and Mrs Brown addresses each with possible control measures. The fire log book contained an up to date record of required checks. These included the fire alarm systems and emergency lighting as well as a visual check of the means of escape and the fire extinguishers. A fire drill had taken place in each identified period although on one occasion the account demonstrated that there were uncertainties about the procedure. Mrs Brown was therefore advised to fully document any such additional training in order to ensure staff were competent with their responsibilities. Staff receive regular fire instruction and this was fully documented as required. The fire risk assessment would also benefit from review, as it was initially undertaken in 2004. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The Registered Person must ensure that all staff sign to demonstrate the administration of medical creams and bath lotions. The Registered Person must ensure that a formal quality assurance system is developed and implemented within the home. Timescale for action 09/05/06 2. YA39 24 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA14 YA42 Good Practice Recommendations The Registered Person should ensure that conditions such as epilepsy are addressed specifically within the individual’s plan of care. The Registered Person should give consideration as to how external and spontaneous events with service users can be evidenced. The Registered Person should ensure that any lack of knowledge identified within a fire drill is addressed and DS0000028497.V291544.R01.S.doc Version 5.1 Page 28 Douglas Arter Centre (The) 4. YA42 fully documented within the fire log book. The Registered Person should ensure that the fire risk assessment is regularly reviewed. Douglas Arter Centre (The) DS0000028497.V291544.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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